This application claims priority from a U.S. Provisional Patent Application to Patterson, et. al, filed May 5, 2000, entitled xe2x80x9cUpper Extremity Rehabilitation and Training Device and Methodxe2x80x9d.
This invention relates generally to training and rehabilitation of the upper extremities using inertial resistance.
Most functional activities, such as competitive sports, require coordinated movement of and function at multiple muscles and joints. An example of such an activity is the act of throwing a baseball, which requires coordinated use of, inter alia, the muscles serving the hand/wrist, elbow, shoulder, and scapular muscle-joint complexes. Each of these muscle-joint complexes includes major and minor mover muscles, which flex-extend, adduct-abduct, supinate-pronate, stabilize and rotate. These four muscle-joint complexes are collectively referred to as the upper extremity kinetic chain.
To effectively throw a baseball optimally and avoid injury, a player must be able to coordinate both the major and minor movers as well as the stabilizer and rotator muscles of the entire upper extremity kinetic chain. If this coordination is less than optimal, injury and/or diminished performance often result. As a consequence, in order to optimally train and/or rehabilitate the upper extremities for real life and/or real sport expression of maximal upper body performance potential, coordinated, neuro-muscularly efficient, four-muscle-joint-complex training of the entire upper extremities"" kinetic chains is necessary.
The use of various devices, such as barbells, dumbbells, and exercise machines, for rehabilitation, fitness, and performance enhancement of athletes and other individuals is well known. These devices use some type of inertial resistance against which one or more of an exerciser""s muscle groups exert.
Dumbbells are often used for training the upper extremities and typically consist of a handle connecting a pair of weighted discs. A dumbbell is typically balanced so that its center of gravity is located at the middle of its handle, so that an exerciser can grasp the handle with one hand and perform inertial-resistance exercises.
Barbells are also primarily used for training the upper extremities. They typically consist of a relatively elongated cylindrical bar used as a handle that connects a pair of weighted discs, the bar most often being gripped by an exerciser with both hands while performing inertial-resistance exercises. The center of gravity of a barbell is normally positioned in the center of the bar between the weighted discs, which position allows an exerciser to balance the barbell in both hands while performing inertial-resistance exercises. Barbells are normally either made so that weighted discs can be slid on and off the bar or with fixed weighted discs permanently attached. Dumbbells and barbells are collectively termed free weights.
Numerous exercise machines have been devised to train and/or rehabilitate the upper extremities. Exercise machines most often consist of an inertial resistance such as a weight, elastic member or flexible member, hydraulic piston, or the like, which is connected to a part of an exerciser""s body by a handle, pad, stirrup, strap, or other means for transferring force applied by muscular effort by the exerciser via a cable, lever, or other connective means to the inertial resistance.
One drawback to prior art free weights and exercise machines is their inability to exercise the stabilizer and rotator muscles of the upper extremity kinetic chain. This is due to the fact that free weights and machines involve two-dimensional exercise movement paths while stability and rotational strength stimuli require three dimensional exercise movement paths. During prior art upper extremity free weight and exercise machine exercises, one or both hands are typically used to grasp an exercise machine handle, barbell or dumbbell. An exerciser""s hand/wrist is normally fixed in either a fully supinated or in a partially pronated position. A prior art barbell biceps curl, for example, is typically performed with the hand/wrist in a fully supinated position and in a static isometric contraction. Other than a limited static hand/wrist muscle-joint resistance to extension/flexion that occurs as the wrist is statically held in a neutral position between full wrist flexion and full wrist extension, there is no further hand/wrist muscle-joint complex flexion/extension, supination-pronation, or ulnar-radial deviation training stimulus. Moreover, there is no hand/wrist muscle-joint complex range of motion stimulus and little or no stability strength stimulus since the center of gravity of the bar or handle is located in the center of the exerciser""s fist.
In a prior art barbell biceps curl, the exerciser""s hand/wrist muscle-joint complex does not have to stabilize with respect to radial/ulnar deviation, nor does the elbow muscle-joint complex have to resist supination/pronation. Thus, an upper extremity exercise such as the barbell biceps curl is designated a dead hand exercise, because it stresses the elbow flexor muscles (i.e., the major movers for a barbell biceps curl) almost exclusively, and, at best, only minimally stimulates the stabilizer muscles of the upper extremity kinetic chain, including the hand/wrist, the limited isometric flexion/extension of the hand/wrist muscle-joint complex discussed above being the minimal stabilizer stimulus. The term dead hand refers to an essentially fixed isometrically contracted hand-wrist position which predominates during the use of a traditional barbell in particular, dumbbell use to a lesser degree, and most exercise machines. The isometric dead hand position is neutral between wrist flexion and extension, and wrist ulnar and radial deviation. Once the start position of a dead hand exercise is assumed, the hand-wrist remains isometrically fixed for the duration of the exercise.
Another of the drawbacks of prior art free weights and exercise machines is their inability to provide moment arm variations in the exercises they are designed to allow a exerciser to perform. The term moment arm variations refers to the ability to change not only the amount of inertial resistance applied during the exercise, but also its point of application, so that the torque, linear resistance, and/or stabilizing resistance applied to the upper extremity kinetic chain can be varied and customized to train strength and flexibility across all movement potentials of all four muscle-joint complexes of the upper extremity kinetic chain.
By variation of the moment arms applied to the upper extremity kinetic chain during an exercise, changes in the resistance curve of the exercise and the stress placed on the major and minor movers as well as the rotator and stabilizer muscles of the upper extremity kinetic chain during the exercise could be varied so that the rehabilitation and training goals of the exercise could be more readily and optimally achieved. Optimal training and rehabilitation requires full anatomic range of motion movement capability across the hand/wrist, elbow, shoulder, and scapular muscle-joint complexes with four-dimensional strength-stimulus (i.e., forward/backward, side-to-side, up-down, and rotational) to provide optimal training of the upper extremity kinetic chain. Such optimal training enables maximal speed and power expression in all movement potentials. In addition, the ability to vary the moment arm permits an exerciser to more precisely tailor the exercise to a real-world and/or real sport activity for which he wants to train and/or rehabilitate. Unfortunately, prior art exercises and devices do not permit such optimal training or rehabilitation.
It is well known that a prior art dumbbell can be used with a single slightly varying moment arm along the axis of the handle, which extends between the two weighted discs. In particular, an exerciser sometimes will grip the handle of the dumbbell with one side of their fist abutting against one of the weighted discs so that the center of gravity of the dumbbell is no longer in the center of the fist. By so doing, the exerciser can slightly vary the moment arm in such a way as to increase the torque applied, for example, during either pronation or supination of the elbow muscle-joint complex. However, the ability of a prior art dumbbell to accommodate moment arm variations is limited and does not adequately stimulate the rotator and stabilizer muscles of the upper extremity kinetic chain because the supination/pronation function of the elbow muscle-joint complex is minimally stressed, while the other muscles of the upper extremity kinetic chain remain basically unaffected.
The application of the dumbbell fly exercise to the four-joint kinetic chain illustrates the delimited training effect of prior art training. Throughout the exercise, the hand/wrist remains in a isometrically contracted position mid-way between flexion and extension and between radial and ulnar deviation once the dumbbell has been grasped. Similarly, throughout the exercise, the forearm is pronated in an isometric contraction. During the exercise, the elbow is partially flexed while the shoulder performs lateral abduction. Thus, the exercise is essentially two-dimensional and there is little or no rotational or stability-strength stimulus and the exerciser is only performing the exercise in opposition to the pull of gravity.
Prior art barbells and exercise machines are even more limited than dumbbells with respect to moment arm variations, both in the number and degree of moment arm variations that are possible and in their ability to train the rotator and stabilizer muscles of the upper extremity kinetic chain as a result of the variations. Exercise machines typically provide no moment arm variations during the course of an exercise. Moreover, the number and degree of moment arm variations, if any, provided by an exercise machine, would by necessity be fixed by the machine""s structure, which would also eliminate stimulus of the stabilizer muscles, given that exercise machines do the stabilizing for the exerciser and thus allow the exerciser to work only the major movers at a single joint, as a result of the machines"" fixed exercise movement paths.
Prior art barbells are even more unsuited for application of moment arm variations because of their typical use while in an exerciser""s hands; it is therefore apparent that if an exerciser were to attempt to vary the moment arm, for example, by gripping the barbell off center, either removable weights could slide off the bar or the exerciser could be placed in danger as a result of losing control of the barbell. This would especially be true with respect to pressing movements in which the exerciser is underneath the bar.
Another drawback associated with free weights and exercise machines is their inability to adequately correct an exerciser""s limited range of motion in one or more of the four muscle-joint complexes of the upper extremity kinetic chain so that the exerciser can perform a given exercise to his or her full anatomic potential range of motion. Moreover, the larger the stature of the exerciser, the more the fixed design of an exercise machine delimits the effective range of motion available to the exerciser.
An exerciser""s limited range of motion is often also due to the presence of chronically contracted groups of muscle fibers commonly referred to as muscle spasm. Muscle spasm inherently inhibits movement, by neuro-muscular reflex action, particularly movement toward the extremes of a given joint""s range of motion. In most cases, the spasmed muscle fibers are not under conscious control and, when called on to move a joint structure into an unfamiliar part of a given range of motion, trigger further contraction, by protective reflex, of adjacent muscle(s) in an effort to protect the muscle-joint complex from injury or further injury. The spasmed muscle tissue can be disrupted or torn more easily due to its lowered elasticity. In addition, muscle spasm causes decreased blood and lymphatic fluid flow to the spasmed tissue, and resultant slowed healing, as well as impaired performance due to pain and decreased range of motion.
Unfortunately, optimal release of muscle spasm and reset of muscle tonus is unachievable using prior art free weights and exercise machines. Prior art exercise machines limit range of motion due to their two-dimensional fixed movement paths, and are largely dimensionally fixed; as such, they do not optimally accommodate different-sized exercisers. They also provide little or no stability strength stimulus because the machine stabilizes the weight for the exerciser. Free weights are only marginally effective at resetting muscle tonus because they operate only against gravity and provide little or no rotational stimulus. As such, free weights provide only two-dimensional strength stimulus; therefore, primary rotators, such as the teres major and popliteus, can go into spasm, remain in such a state, and inhibit movement via protective inhibition.
Spasming of muscle fibers in stabilizer and rotator muscles commonly occurs as these muscle groups become progressively weaker in relation to major movers. Prior art free weight and exercise machine exercises are simply not able to provide the training stimuli necessary to fully develop the functional capacity of these specialized muscles. As such free weight and/or machine exercises are repeatedly performed, strength and flexibility (i.e., range of motion) imbalances are either created or are magnified as the major movers targeted by prior art exercise machine and free weight exercises become stronger, while the stabilizer and rotator muscles become comparatively unconditioned (i.e., relatively weak, often with relatively more muscle spasm). Once such muscle imbalances are present, the stabilizer/rotator muscles tend to spasm (i.e., chronically contract) to protect the related joint structure(s) and themselves from damage caused by the action of the ever-stronger major movers.
Perhaps even more significant is the pain that results from chronically spasmed muscle tissue, given that not only the involved muscle tissue but also related nerve structures are chronically in circulatory deficit with respect to both blood and lymphatic fluid. To reset muscle tonus to normal levels requires exercises that offer a comprehensive full range of motion across rotary, flexor/extensor, supinator/pronator, and exercise movement and a complete array of slow speed to high speed training stimuli. Prior art free weights and machines are heavily momentum-limited in that once an exerciser moves the weight quickly, the weight develops momentum and then must be slowed down. This causes safety risks and injury potential, thus requiring that free weights and most machines be used at slow to moderate exercise speeds. The negative phase of these exercises usually involves lowering the weight in response to gravity, during which lowering slow exercise speeds are required. High exercise speeds are not usually advisable under these conditions and full range of motion movements are usually avoided.
Prior art free weights and exercise machines fail to provide this range of training stimuli, largely because of their inability to completely train the stabilizer/rotator muscles, let alone provide comprehensive training of the entire upper extremity kinetic chain. Full anatomic ranges of motion are simply not possible, and thus the alleviation of muscle spasm and the resetting of muscle tonus is also not possible.
Another drawback of prior art free weights and exercise machines is that they are based on a single-joint-dominant training mode model, in which only major movers are stressed and development of stabilizer/rotator muscles is neglected. An example of a single-joint-dominant training mode exercise is the prior art barbell biceps curl. In the prior art barbell biceps curl, only the elbow muscle-joint complex flexor muscles (i.e., biceps) are stressed, to the exclusion of the biceps"" role as a supinator of the hand/wrist muscle-joint complex, while the rotator/stabilizer muscles of the upper extremity kinetic chain, including the hand/wrist, shoulder, and scapular complexes are relatively neglected. As a result of the single-joint dominant training mode model, prior art free weights and exercise machines have been used to train the major movers solely as flexors and extensors, emphasizing flexion/extension of hand/wrist and elbow joint and adduction/abduction of the shoulder joint. They have all but ignored the rotary and stabilization functions of both major and minor movers across all four joints of the upper extremity kinetic chain.
In contrast, real-world activities, such as a baseball throw, require coordinated action of the minor and major movers, particularly their rotational and stabilization functions, of the entire upper extremity kinetic chain. Thus, the use of prior art free weights and exercise machines can create muscle strength imbalances as major movers are strengthened as flexors and extensors, while the exerciser""s rotary and stabilization functionality becomes relatively less. Once the exerciser then attempts to engage in a real-world or real-sport activity that calls on the major and minor movers to act in a coordinated three-dimensional fashion, decreased performance and/or injury become more and more likely.
Virtually all real-world upper extremity movements involve the upper extremity kinetic chain performing one or more of ten movements: hand/wrist radial deviation; hand/wrist ulnar deviation; hand/wrist flexion; hand/wrist extension; forearm supination; forearm pronation; elbow flexion; elbow extension; scapular protraction; scapular retraction; or various combinations of these movements. These ten movements cannot be fully trained along the entire upper extremity kinetic chain using prior art free weights or machines because movements using such devices are dead-hand movements. In effect the hand/wrist complex is used only for fist/finger flexion in an isometric contraction mode during the entire exercise, and in effect merely acts as a static link between the upper extremity and the free weight or exercise machine so that the load can be applied to the specific major mover(s) of the upper extremity targeted by the exercise.
The statically and isometrically contracted (i.e., dead hand) hand/wrist position of most free weight and exercise machines means that the rotary capability of an exerciser will be undertrained by prior art free weight and machine exercises. The effect of incomplete hand/wrist training has a domino-like effect along the upper extremity kinetic chain. The hand/wrist is not rotary trained; therefore, the elbow is not rotary trained. Once it is recognized, for example, that the biceps is a major mover for supination and that the biceps"" origins are at two different sites in the shoulder joint, all three joint complexes (i.e., hand/wrist, elbow, and shoulder) remain undertrained by prior art free weight and exercise machine exercises.
The development of efficient four-joint coordination and motor patterning resulting in maximal performance expression of the entire upper extremity kinetic chain cannot be achieved unless all four joints of the upper extremity kinetic chain are trained in a coordinated manner that simulates real-world activity. This has been unachievable using prior art free weights and exercise machines.
Another drawback to prior art free weights and exercise machines is their failure to enable the exerciser to fine tune and upgrade their proprioceptive sense to accommodate real-world/sport demands. Proprioception has been generally defined as an organism""s precise sense of where it is in space and where its body parts are in relation to one another. In the context of inertial resistance exercise, proprioception is the ability of an exerciser to know where his body is positioned throughout the exercise range of motion, which allows the muscle fibers specifically, and various muscles generally, to be coordinated and fire in the proper sequence in order to properly execute the desired movement throughout the entire exercise.
If, for example, a baseball pitcher has not been properly proprioceptively conditioned and, as a result, his shoulder muscle-joint complex""s external rotator muscles are strong but other parts of his upper extremity kinetic chain, such as the stabilizer muscles, are weak and/or spasmed, he will be unable to optimally implement the precise motor pattern required to skillfully throw the baseball. This inability will result in a significant chance of injury due to abbreviated ranges of motion caused by spasmed muscle fiber that not only cannot contribute to developing force to throw the ball, but which also inhibits the remaining muscle fiber from developing force maximally and/or explosively.
Imbalance in the stabilizer muscles invariably leads to diminished performance and an enhanced risk of injury. Premature firing of stabilizer/antagonist muscles to decelerate the upper extremity during an attempt to execute a high-speed full range of motion upper extremity kinetic chain movement will often occur. For example, if a javelin thrower has weak and/or spasmed stabilizer muscles anywhere in the upper extremity kinetic chain, the stabilizer/antagonist muscles will tend to contract to inhibit the throwing movement before he has released the javelin. This premature antagonist/stabilizer muscle firing occurs as a protective mechanism (i.e., protective inhibition), in an effort to slow the thrower""s arm so that the major movers do not overpower the weak/spasmed stabilizer muscles and damage them or the joints themselves.
Thus, the javelin thrower could increase his throwing speed not just by training the internal shoulder rotator/stabilizer muscles that contract during a throw, but also by training the antagonist muscles that decelerate the arm, so that the deceleration does not occur prematurely in the motion in order to protect the upper extremity from injury. Unfortunately, prior art free weights and machines do not permit such complex training. Such complex training is not possible using prior art devices and methods because of the limitations of prior art free weights and exercise machines, in that they: 1) require slow lifting speed to control momentum; 2) employ a single-joint-dominant focus; 3) elicit a two-dimensional muscle stimulus; and 4) permit only abbreviated ranges of motion due to either machine design and/or the need to control momentum as the exercise is performed.
Full anatomic range of motion training of the stabilizer/rotator muscles, and release of muscle spasm are inter-related. Being free of muscle spasm (i.e., normal muscle tonus) allows an exerciser to train through a full anatomic range of motion by serving to minimize protective reflex inhibition, which is a natural result of the muscle spasm as the exerciser tries to protect himself from injury. Strength imbalances such as overwhelming the comparatively weak stabilizer/rotator muscles is another source of protective reflex inhibition. Once normal muscle tonus is re-established, pain/premature protective reflex inhibition ceases and full anatomic range of motion exercise is possible. The exerciser can now proceed to use his proprioceptive awareness during full anatomic range of motion exercise to develop highly-efficient movement patterns and new performance potential while maintaining his musculature relatively spasm free.
Strength imbalances between the stabilizer and major mover muscles causes what is known as the cumulative trauma cycle to begin. The cumulative trauma cycle is started when muscle strength imbalance leads to an initial injury to the muscle, which injury leads to muscle weakness and more muscle spasm. Once the muscle starts to become weaker because of the spasm, blood and lymphatic flow through the muscle are decreased. The cycle can become chronic, with further decreased blood and lymph flow to the muscles, increased spasm, and eventually scar tissue formation. Further impaired range of motion and consequent vulnerability of the muscle to more serious injury, including muscle tears, often result.
Another drawback of prior art free weights and machine exercises is their inability to train the muscles of the upper extremity kinetic chain over a full range of motion to full anatomic potential. The ability to train the upper extremities over the full anatomic range of motion is therefore of critical significance as a training and rehabilitation goal, because such training allows an exerciser to attain conscious neuro-muscular control over the full anatomic range of motion for a given exercise, which enhanced range of motion results in both injury resistance and maximal performance expression. Injuries often occur due to insufficient range of motion when an upper extremity joint is taken into an unfamiliar part of range of motion by an external force such as a fall or blow; injury to soft tissue and/or joint structures often results.
Another drawback of many prior art free weights and exercise machines is their size and/or weight. Because most are relatively heavy and cumbersome, often weighing between 100 and 1000 pounds, and requiring as much as 80 cubic feet of floor space, they are not readily transportable.
These and other limitations associated with prior art exercise devices and methods are overcome by the present invention, which is used for rehabilitation and training of the upper extremities. In one aspect of the invention, there is provided a device that is adapted to permit multiple moment arm variations during live-hand exercises of the upper extremity kinetic chain. In another aspect of the invention, a device is provided that can be used to provide a training and rehabilitation stimulus to increase range of motion (i.e., flexibility) of an exercise movement to the level of full anatomic potential that can be used to provide a training and rehabilitation stimulus to increase functional strength capabilities across full anatomic potential ranges of motion.
In yet another aspect of the invention, a device is provided that includes a base having a distal end and a proximal end, an opening at the proximal end adapted for insertion of an exerciser""s hand, and at least one notch formed at at least one of the distal end or the proximal end. The device also includes a handle disposed within the opening of the base. The device can be used to eliminate muscle spasm and reset muscle tonus to normal levels.
In still another aspect of the invention, a device is provided that can be used to improve proprioception and strengthen stabilizer/rotator muscles of the upper extremities. In still another aspect of the invention, a device is provided that increases blood and lymphatic fluid flow to the upper extremity muscles by releasing muscle spasm. In other aspects of the invention, various upper extremity exercises utilizing one or more live-hand devices are provided which serve to solve one or more of the above-described drawbacks associated with the prior art.